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ADHD Does Not Exist

When I first heard that a neurologist had written a book called ADHD Does Not Exist, I felt encouraged. However, after reading yesterday's article inThe New Republic by the books's author, Dr. Rchard Saul, I realized that my feeling of encouragement was premature.

Saul rightly points out that no biological cause for ADHD has been isolated, despite decades of research, and that stimulant drugs for children have their downsides and are in general over-prescribed. However, in the case study Saul describes in The New Republic, the diagnosis and the solution he proposes for a young patient are much worse than the usual stimulant "solution" for ADHD.

Saul tells the story of one of his patients, a 6th grader named William. William was bright but forgetful, having some run-of-the-mill boyhood problems like forgetting to bring home his homework assignments and having the occasional temper tantrum. Frustrated at their son's "underperformance" at school, his parents sought medication solutions for William. They took him to one psychiatrist after another, who prescribed various stimulants and antidepressants for the boy without recommending any form of psychotherapy.

His parents noticed that the medications seemed to make William worse. Instead of looking for causes in William's social environment, or trying family therapy, school interventions, parenting classes, or tutoring, his parents sought out another medical solution--with much more serious consequences.

Saul diagnosed William with bipolar disorder, a diagnosis that has never been applicable to children under eighteen in any edition of the DSM. The FDA has not approved for children any drugs that are approved to treat bipolar disorder in adults. Some psychiatrists, nonetheless, continue to diagnose bipolar disorder in children and prescribe powerful antipsychotic drugs for them "off label."

In William's case, the drug that worked was Lithium. According to the FDA, Lithium is indicated in the treatment of manic episodes of bipolar disorder in adults. Nothing in Saul's description of William suggests that he had anything like a manic episode.

But William's symptoms improved with the Lithium. He remembered to bring home his backpack most of the time and his school work-related tantrums stopped. Saul told William's parents that since bipolar disorder is a chronic illness, he would probably need to take Lithium for the rest of his life. Because Lithium helped William, Saul deduced that the cause of William's problems was the condition for which the drug is usually prescribed: adult bipolar disorder. In using this chain of reasoning, he was making the same mistake as doctors who deduce that a child has ADHD because stimulant drugs help the child's symptoms.

Stimulant drugs like Adderall were used by German pilots during the Blitzkrieg in World War II, and later by English and American bomber pilots. Because stimulant drugs were effective in helping these pilots stay alert and concentrate on long-haul missions, we cannot assume that all of them, or even any of them, had attention deficit hyperactivity disorder.

In the same way, we cannot assume that because Lithium helps a boy to remember to bring home his backpack and behave better at school, the boy therefore must therefore be psychotic. Bipolar disorder is simply a new name for manic-depressive psychosis, which many doctors now believe does not even exist in children.

Finally, Lithium is an toxic drug with extremely dangerous side effects like kidney damage. The FDA page on Lithium bears the warning: "Safety and effectiveness in pediatric patients under 12 years of age have not been determined; its use in these patients is not recommended." It is shocking that a doctor would prescribe such a drug for a boy whose problems could have easily been resolved with family and/or school interventions.

The lion's share of responsibility for the wreckage of today's psychiatry rests with insurance companies. The quickest and most profitable route for treatment of psychological maladies is the medical one, with the "take two pills and never call me back" modality usurping the "let's take some time and sort this out" of the talking cure. Of course, the AMA is complicit in all of this, by not pushing back against their paymasters in the interests of their patients, but we probably won't fix any of this until we get single payer. Obamacare, unfortunately, still lets the foxes guard the hen house.

Has any thought at all been given to teaching these kinds of kids transport sport lifestyle? Cycling, footbiking,endurance longboarding, Nordic ski, inline skate, sup, spikeboarding lifestyles generate focus while delivering short term goals and most importantly maintaining long term goals for life. They provide transport skills and they have profound metabolic and neurological affects when practiced daily for 2 hours at a time. Were it not for transport sport lifestyle my life would be hopelessly in dark distant depression or perhaps dead as many as my colleagues that self medicated themselves to death. All their energy and unbridled focus turning in on themselves as a destructive force.

It such a common phenomena. Giving Drugs to ordinary children because they show some child like behavior. There are so many ways to deal with ADHD naturally even when the diagnosis is right. Yet the doctors seem to have no problem prescribing drugs even before they sure the child actually does have adhd.

I just finished this book, and as the creator of The Adult ADHD Blog, I have a few things to say:

- While I applaud Dr. Saul's passion, I feel he is way off. Sure, we don't yet have research to make this a bang-on underlying cause of a diagnosis, but SO WHAT? That certainly doesn't mean it's bipolar, depression, giftedness, or anything else!!!

This guy needs to keep an open mind, as I'm trying to do. The dam suggestion he puts out is absolutely rash and un-founded. YES, there are a ton of mis-diagnoses. I agree! But don't you dare say that ADHD isn't in itself a condition.

It just doesn't add up, Dr. Saul. My gut tells me that, and research will show us. It's coming!

I have adhd and its not a condition its a GIFT
you are focust on anything
So you forget things and sure there are drugs that help you but every one of m have side effects you just need to guid m tell m what he needs to remember adhd children dont even know why their mind is so drifting off

I have adhd and its not a condition its a GIFT
you are focust on anything
So you forget things and sure there are drugs that help you but every one of m have side effects you just need to guid m tell m what he needs to remember adhd children dont even know why their mind is so drifting off

I wonder what's happening with kids.There are so many tools to enhance the efficiency of kids at school.I may agree but who will take the responsibility of the upcoming negative result and side effects.steroids

I am an adult with ADD. I've had ADD since I was a child. It was clear I was "different" from an early age, like VERY different. I almost flunked out of middle and high schools, I turned it around in high school with behavioral intervention, no drugs, but I still have trouble focusing. I eat a low carb diet and stay hydrated (although no food and caffeine is the best method, albeit unsustainable to drink coffee and no food), much different from the diet I had as a child. I'm active now, I was active then. I was inactive for awhile too (the time I did the worst in school). I still have similar problems: impulsiveness that's only been quashed by anxiety and depression but otherwise still there, disorganization (constantly losing/forgetting things despite being able to remember other trivial things really well), starting 4 things and finishing none because I get worn out or distracted and not even trying to do so... point is, it's real, and I live it. Sometimes I don't realize I'm daydreaming until an hour later. This was all before the huge reliance on the internet and tablets and smartphones and such that I knew this... second or third grade, in the 90s. And it's still here, I can manage it better (again, caffeine, actual life pressures, no food or few carbs, weightlifting before sitting down to do paperwork) but it's still here.
NOW, it's overdiagnozed and overmedicated, I get that completely. But real, it is.
I could go on, but I'm already rambling, and I actually have 8 other tabs open I need to deal with before I got distracted with this for some reason I can't remember.